Birmingham, AL, United States
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Liang S.-Y.,Taipei Veterans General Hospital | Yang T.-F.,Taipei Veterans General Hospital | Chen Y.-W.,National Yang Ming University | Chen Y.-W.,Taipei Veterans General Hospital | And 7 more authors.
Neuro-Oncology | Year: 2013

Background. The notable survival chances of intracranial germ cell tumors (icGCTs) lead to a rising concern over long-term neurocognitive outcome. Yet, prior evidence related to this issue fails to provide a comprehensive examination of the effects of tumor location and radiotherapy. We attempt to explore their impacts on the neuropsychological functions and life quality in children with icGCT after multimodality treatments. Methods. Aretrospective reviewof 56 patients diagnosed with icGCTs at age,20 and treated at theTaipeiVeterans General Hospital was provided. Intelligence, memory, visual organization, attention, and executive function were assessed by neurocognitive tests; adaptation to life, emotional and behavioral changes, interpersonal relationships, and impact on the family were evaluated by parentreport instruments. Effects of tumor locations (germinomas and nongerminomatous malignant germ cell tumors in the pineal, suprasellar, and basal ganglia) and irradiation on these measurements were examined. Results. Patients with tumors in the basal ganglia region had lower full-scale IQs than those with tumors in the pineal or suprasellar regions. Subscores of intelligence scale and short-term retention of verbal and visual stimuli showed evident group differences, as did the quality oflife and adaptive skills, particularly in psychosocial domains. Patients treated with whole-ventricular irradiation had better outcomes. Extensive irradiation field and high irradiation dosage influenced intellectual functions, concept crystallization, executive function, and memory. Conclusions. Tumor location and irradiation field/dosage appear to be the crucial factors related to certain neuropsychological, emotional, and behavioral dysfunctions that in turn alter the quality of life in children with icGCTs who survive after treatment. © The Author(s) 2013.

Griessenauer C.J.,University of Alabama at Birmingham | Rizk E.,Pediatric Neurosurgery | Miller J.H.,University of Alabama at Birmingham | Hendrix P.,University of Alabama at Birmingham | And 4 more authors.
Journal of Neurosurgery: Pediatrics | Year: 2014

Object. Tectal plate gliomas are generally low-grade astrocytomas with favorable prognosis, and observation of the lesion and management of hydrocephalus remain the mainstay of treatment. Methods. A cohort of patients with tectal plate gliomas at 2 academic institutions was retrospectively reviewed. Results. Forty-four patients with a mean age of 10.2 years who harbored tectal plate gliomas were included in the study. The mean clinical and radiological follow-up was 7.6 ± 3.3 years (median 7.9 years, range 1.5-14.7 years) and 6.5 ± 3.1 years (median 6.5 years, range 1.1-14.7 years), respectively. The most frequent intervention was CSF diversion (81.8% of patients) followed by biopsy (11.4%), radiotherapy (4.5%), chemotherapy (4.5%), and resection (2.3%). On MR imaging tectal plate gliomas most commonly showed T1-weighted isointensity (71.4%), T2-weighted hyperintensity (88.1%), and rarely enhanced (19%). The initial mean volume was 1.6 ± 2.2 cm3 and it increased to 2.0 ± 4.4 cm3 (p = 0.628) at the last follow-up. Frontal and occipital horn ratio (FOHR) and third ventricular width statistically decreased over time (p < 0.001 and p < 0.05, respectively). Conclusions. The authors' results support existing evidence that tectal plate gliomas frequently follow a benign clinical and radiographic course and rarely require any intervention beyond management of associated hydrocephalus. ©AANS, 2014.

Davis M.C.,University of Alabama at Birmingham | Griessenauer C.J.,University of Alabama at Birmingham | Bosmia A.N.,St. George's University | Tubbs R.S.,St. George's University | And 2 more authors.
Clinical Anatomy | Year: 2014

The giants of medicine and anatomy have each left their mark on the history of the cranial nerves, and much of the history of anatomic study can be viewed through the lens of how the cranial nerves were identified and named. A comprehensive literature review on the classification of the cranial names was performed. The identification of the cranial nerves began with Galen in the 2nd century AD and evolved up through the mid-20th century. In 1778, Samuel Sömmerring, a German anatomist, classified the 12 cranial nerves as we recognize them today. This review expands on the excellent investigations of Flamm, Shaw, and Simon et al., with discussion of the historical identification as well as the process of naming the human cranial nerves. Clin. Anat. 27:14-19, 2014. © 2013 Wiley Periodicals.

Ranger A.M.,Pediatric Neurosurgery | Ranger A.M.,University of Western Ontario | Chaudhary N.,University of Western Ontario | Avery M.,University of Western Ontario | Fraser D.,University of Western Ontario
Journal of Child Neurology | Year: 2012

This study aimed to identify the causes and contributing factors, neurologic presentation, and outcomes of central pontine and extrapontine myelinolysis and to examine any trends in the presentation and course of these disorders over the past 50 years. Seventy-six pediatric cases were identified in the literature. Age, sex, decade of diagnosis, neurologic presentation, outcome, and attributed causes were extracted. The results showed that the diagnosis, course, and outcomes of central pontine and extrapontine myelinolysis clearly have changed over the past few decades. Early cases generally were diagnosed at autopsy as opposed to computed tomography or magnetic resonance imaging more recently. Ninety-four percent of cases prior to 1990 and only 7% of cases from 1990 onward resulted in patient mortality. The decade in which the case was reported was the strongest predictor of outcome (P <.001), followed by sodium dysregulation (P =.045) and dehydration (P =.07). © The Author(s) 2012.

Mortazavi M.M.,University of Washington | Verma K.,Pediatric Neurosurgery | Harmon O.A.,Pediatric Neurosurgery | Griessenauer C.J.,Pediatric Neurosurgery | And 3 more authors.
Clinical Anatomy | Year: 2015

Spinal cord injury is a highly prevalent condition associated with significant morbidity and mortality. The pathophysiology underlying it is extraordinarily complex and still not completely understood. We performed a comprehensive literature review of the pathophysiologic processes underlying spinal cord injury. The mechanisms underlying primary and secondary spinal cord injury are distinguished based on a number of factors and include the initial mechanical injury force, the vascular supply of the spinal cord which is associated with spinal cord perfusion, spinal cord autoregulation, and post-traumatic ischemia, and a complex inflammatory cascade involving local and infiltrating immunomodulating cells. This review illustrates the current literature regarding the pathophysiology behind spinal cord injury and outlines potential therapeutic options for reversing these mechanisms. Clin. Anat. 28:27-36, 2015. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

Loukas M.,St. George's University | Saad Y.,St. George's University | Tubbs R.S.,Pediatric Neurosurgery | Shoja M.M.,Indiana University
International Journal of Cardiology | Year: 2010

Descriptions of the human anatomy derived from religious texts are often omitted from the medical literature. The present review aims to discuss the comments and commentaries made regarding the heart and cardiovascular system as found in the Qur'an and Hadeeth. Based on this review, it is clear that these early sources both had a good comprehension of these parts of the body. © 2009 Elsevier Ireland Ltd. All rights reserved.

Mortazavi M.M.,University of Washington | Harmon O.A.,Pediatric Neurosurgery | Adeeb N.,Pediatric Neurosurgery | Deep A.,Pediatric Neurosurgery | And 3 more authors.
Clinical Anatomy | Year: 2015

Over time, various treatment modalities for spinal cord injury have been trialed, including pharmacological and nonpharmacological methods. Among these, replacement of the injured neural and paraneural tissues via cellular transplantation of neural and mesenchymal stem cells has been the most attractive. Extensive experimental studies have been done to identify the safety and effectiveness of this transplantation in animal and human models. Herein, we review the literature for studies conducted, with a focus on the human-related studies, recruitment, isolation, and transplantation, of these multipotent stem cells, and associated outcomes. Clin. Anat. 28:37-44, 2015. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

Frassanito P.,Pediatric Neurosurgery | Frassanito P.,Pediatric Neurosurgery Unit | Massimi L.,Pediatric Neurosurgery | Caldarelli M.,Pediatric Neurosurgery | And 2 more authors.
Acta Neurochirurgica | Year: 2012

Background Decompressive craniectomy is an effective treatment option in case of refractory intracranial hypertension after severe head injury. The incidence of complications following cranial repair after decompressive craniectomy for traumatic brain injury is not negligible, particularly in infants and young toddlers. However, only a few dedicated papers can be found in the literature. Method We describe the complications observed in two boys and one girl under 1 year of age that were treated in the last decade by hemicranial decompressive craniotomy and enlarging hemispheric duraplasty, and subsequent cranial repair by means of autologous bone-flap replacement. Findings Despite good clinical and neurological outcome, the postoperative clinical course was complicated in all cases by early or late evidence of subdural fluid collections associated to the occurrence of hydrocephalus and causing recurrent dislocation and progressive resorption of the autologous bone flap. Conclusions Infants less than 1 year old, undergoing decompressive craniectomy after traumatic brain injury, experience a high rate of complications following subsequent cranial repair. Subdural collections and resorption of the autologous bone flap are to be considered as extremely common complications. © Springer-Verlag 2012.

News Article | February 20, 2017

When a child suffers a mild head injury, doctors have well-established protocols for determining whether that child should have a computed tomography (CT) scan to assess the damage. Most children with mild traumatic brain injury have normal CT scans—a scenario referred to as a concussion. If a CT scan is abnormal, however, a child’s condition is at higher risk of deteriorating, requiring monitoring in a hospital. But there is little consensus about how closely such children should be monitored. Some children recover well, while others experience a neurological decline and need surgery to relieve brain swelling. Pediatric neurosurgeons have developed a risk scoring system intended to help determine whether a child with mild traumatic brain injury and an abnormal CT scan can be monitored safely in a general hospital ward or requires the increased surveillance of an intensive care unit. “We want to care for these children in the safest way possible and at the same time not place kids unnecessarily in ICUs if they don’t need that level of care,” says senior author David D. Limbrick, professor of neurological surgery and of pediatrics and director of the Division of Pediatric Neurosurgery at Washington University in St. Louis. “We have identified factors that indicate which of these patients are likely to experience neurological decline and require surgery and which are not. This information can help health-care providers decide where to place these children when they are admitted into the hospital.” For the study in JAMA Pediatrics, researchers plumbed data from more than 40,000 children evaluated from 2004 to 2006 at 25 North American hospital emergency departments. The information originally comes from a study conducted by the Pediatric Emergency Care Applied Research Network, which established the standard framework for deciding whether a child with a mild head injury should have a head CT scan. Researchers returned to this data set for guidance on how to handle the subset of children who receive CT scans and are shown to have abnormal findings on the scans. Of the 40,000 children enrolled in the study, 15,000 had CT scans following mild traumatic brain injury. Of these, 839 patients showed abnormalities on the CT scan, such as a brain bleed. These types of injuries are serious enough that some children will experience a neurological decline and need surgery to relieve swelling or pressure on the brain. In the United States, traumatic brain injury leads to almost 600,000 emergency room visits annually. Of new pediatric brain injury cases, more than 90 percent are determined to be mild. About one-third of the 50,000 to 60,000 children hospitalized each year due to head trauma have mild traumatic brain injury. Based on an analysis of the injuries these patients suffered and how they recovered, the investigators developed a risk score ranging from zero to 24 points, called the Children’s Intracranial Injury Decision Aid score. Higher scores indicate the patient is at higher risk of neurological decline and should receive increased monitoring. Lower scores mean a patient is at lower risk of neurological decline. A score of zero indicates the child is at very low risk. The chance that such a child would go on to experience a neurological decline that requires surgery is less than 1.5 percent, according to the analysis. As a general rule, children with scores of less than three points can safely be admitted to a general ward. Patients with higher scores should receive increased surveillance up to and including that provided in an ICU. “There is a lot of variability in how these patients are managed,” says first author Jacob K. Greenberg, a neurosurgery resident. “When we looked back at the data, we saw situations where children were perhaps put in the ICU but didn’t need to be there. And conversely, some patients were placed in a general ward when their risk factors suggested they needed closer monitoring. We are trying to develop this evidence-based tool to help guide and standardize this decision-making process.” The score is determined by four factors that the researchers found most predictive of patient outcomes. One factor is called the Glasgow Coma Scale (GCS), which is used to measure how alert and responsive a patient is after a blow to the head. Fifteen is the highest and best GCS score, meaning the patient can open his or her eyes spontaneously, follow commands to move different body parts and answer questions clearly and appropriately. While the GCS is based on a doctor’s interaction with a patient, the other three factors are determined based on an analysis of a CT scan. The biggest risk factors seen in a CT image are a depressed skull fracture and what is referred to as a midline shift, when the symmetrical structures of the brain are pushed off-center. The final risk factor is an epidural hematoma—a blood clot between the outer layer of the brain’s protective covering and the inside of the skull. Patients with mild traumatic brain injury who show these features on a CT scan and also have a lower GCS score are at high risk of experiencing a neurological decline and, according to the researchers, should be cared for in an ICU. “There are a variety of potential harms associated with sending a patient to an inappropriate location,” Greenberg says. “I think the most important is that if you send a child who needs the ICU into a general hospital ward, you risk missing a potential decline that could have been caught earlier. If the patient experiences new weakness or worsening mental status, for example, the goal is to intervene as quickly as possible to avoid permanent disability or even death. “On the other hand, if you send too many patients to the ICU, there are significant financial costs there, as well as emotional costs for the family,” he says. “Another concern is the limited space available in pediatric ICUs. Having children in the ICU who don’t need to be there is taking beds away from other patients who do need those resources.”

News Article | November 2, 2016

WASHINGTON, Nov. 2, 2016 /PRNewswire-USNewswire/ -- The Image Gently Alliance, American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP), AANS/CNS Joint Section on Pediatric Neurosurgery and allied medical organizations have launched the "Think A-Head" campaign...

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